Talk:Electronic cigarette

Systematic Review not accepted?

So... you're not accepting this systematic review?Why? It's a published, peer-reviewed secondary source! --Merlin 1971 (talk) 16:24, 8 May 2014 (UTC)

It appears that their are a couple of issues. One was it was a copyright violation. We must paraphrase.

The other is that it is not pubmed indexed. Will need to look at the whole article. Doc James (talk · contribs · email) (if I write on your page reply on mine) 00:35, 19 May 2014 (UTC)

My university carries it. Should be usable with appropriate wording. It does say "Riccardo Polosa is a Professor of Medicine and is supported by the University of Catania, Italy. He has received lecture fees and research funding from GlaxoSmithKline and Pfizer, manufacturers of stop smoking medications. He has also served as a consultant for Pfizer and Arbi Group Srl (Milano, Italy), the distributor of Categoria™ e-Cigarettes. His research on electronic cigarettes is currently supported by LIAF (Lega Italiana AntiFumo)." Doc James (talk · contribs · email) (if I write on your page reply on mine) 00:38, 19 May 2014 (UTC)

I removed it due to lack of MEDLINE indexing. We have plenty of secondary sources, no need to use sub-optimal ones. Yobol (talk) 00:39, 19 May 2014 (UTC)

Sure... I can already see what happens here... This is WP, right? Not a political webpage, is'nt it?--Merlin 1971 (talk) 20:03, 19 May 2014 (UTC)

There's no requirement for sources to be either PubMed or MEDLINE indexed.--FergusM1970^{Let's play Freckles} 00:30, 21 May 2014 (UTC)

We have better sources on this topic. QuackGuru (talk) 04:09, 21 May 2014 (UTC)

"Better" in what way?--FergusM1970^{Let's play Freckles} 15:53, 21 May 2014 (UTC)

I'll second Fergus here, and add the comment that we actually do not have "plenty of secondary sources", Pubmed search coughs up 70 reviews, where most are non-related (papers such as "Impact of diet and exercise on lipid management in the modern era.") or so old that they are basically useless. --Kim D. Petersen 16:23, 21 May 2014 (UTC)

User:Yobol, it has been a while since I have read WP:MEDRS, but is that really something that is supported by policy? MEDLINE indexing isn't the be-all and end-all. This article is listed in EMBASE, as a quick search shows me, and there is only a 34% overlap between those two databases (doi: 10.1097/BLO.0b013e31802c9098). NW (Talk) 17:30, 22 May 2014 (UTC)

Under "Biomedical journals" in WP:MEDRS, "Other indications that a journal article may not be reliable are its publication in a journal that is not indexed in the bibliographic database MEDLINE..." This has been a necessary addition to MEDRS due to the proliferation of genuinely bad journals out there. MEDLINE indexing seems to be a fairly low bar to hurdle (crap journals like Homeopathy are MEDLINE indexed, after all). Yobol (talk) 01:48, 23 May 2014 (UTC)

@Yobol: Thanks for the quote. This is a conversation for a different page, WT:MEDRS or WT:MED, but briefly: I disagree with that statement. Nearly every bit of systematic review writing advice, including PRISMA, stress that relying on just one database, even MEDLINE, will lead to biased results. Now that is less of an issue for Wikipedia than writers of systematic reviews, but the principles are similar. Journals that aren't listed in PubMed but do show up in EMBASE or Web of Science Science Citation Index aren't necessarily unreliable. NW (Talk) 02:47, 23 May 2014 (UTC)

Happy to take it to either of the aforementioned talk pages to discuss further. Yobol (talk) 03:04, 23 May 2014 (UTC)

FDA

Is the FDA website a reliable source? See diff. QuackGuru (talk) 20:48, 18 May 2014 (UTC)

This would be a position statement from a internationally recognised expert body. So yes Doc James (talk · contribs · email) (if I write on your page reply on mine) 00:35, 19 May 2014 (UTC)

If I suspected that might be the case then I would not have removed it but clearly the "Adverse Event Reports for e-Cigarettes" section of the FDA page is not a position statement. The section is merely a relaying of information that happens to consist of a summarisation of anecdotal reports. The FDA themselves state that "Whether e-cigarettes caused these reported adverse events is unknown. Some of the adverse events could be related to a pre-existing medical condition or to other causes that were not reported to FDA."

There are various anecdotal yet compelling reports out there of how e-cigarettes have had a positive impact on a person's health, yet obviously we should not introduce those due to their very nature. It is therefore impossible to balance these unconfirmed side-effects with any opposing views due to the fact that firm evidence of either simply does not exist. Whilst I am not saying that absence of an opposing valid source invalidates the original source I do think that we have to be careful to maintain a NPOV. In this case I find it hard to justify alarming, unproven medical reports that would likely remain unchallenged.Levelledout (talk) 00:55, 20 May 2014 (UTC)

In general, the FDA is a reliable source. However, that particular piece of information is a voluntary reporting of possible adverse events (possible form of selection bias) and the FDA has not confirmed any of those events were actually caused by e-cigarettes. I'm not sure it deserves to be included given the tentative nature of the data; if it is included, we have to be sure to note that it is unknown if these events are actually caused by the e-cigarettes (which would argue against even putting it in in the first place). Yobol (talk) 00:43, 19 May 2014 (UTC)

It is kind of hard to work out what the point of it is. Right now the article basically says "E-cigs cause all sorts of diseases. Except we're just saying that; there's no evidence."--FergusM1970^{Let's play Freckles} 00:48, 21 May 2014 (UTC)

"The FDA has received voluntary reports of adverse events involving e-cigarettes which include hospitalization for illnesses such as pneumonia, congestive heart failure, disorientation, seizure, hypotension, and other health problems but it is unknown whether e-cigarettes caused these adverse events."

As long we are using a reliable source and the text is neutrally written I think it is okay. QuackGuru (talk) 17:35, 19 May 2014 (UTC)

But what's the point of it? All it really says is "some people who use e-cigs got ill." Great. Some people who don't use e-cigs got ill too. I honestly can't see what it adds to the article.--FergusM1970^{Let's play Freckles} 15:42, 21 May 2014 (UTC)

I am going to remove it, since it is A) A primary source for this info per WP:MEDRS B) per WP:MEDASSESS this is just about as poor information as is possible. Without analysis these are simply anecdotal. --Kim D. Petersen 21:24, 21 May 2014 (UTC)

I agree, what I don't get is how the information got back there in the first place. In the middle of a dispute, it seems to have reappeared like magic. Anyone know where the diff is? Combined with other things I am beginning to think that there are some genuine issues occurring regarding this article.Levelledout (talk) 22:08, 21 May 2014 (UTC)

Was reintroduced here. --Kim D. Petersen 23:31, 21 May 2014 (UTC)

I don't think it should be in the article, and I don't think the other sentence, "Although some people have a desire to quit smoking by using e-cigarettes, other common explanations for the use of these products are to evade smoke-free laws and to cut back on traditional cigarettes, which may reinforce delaying or deterring to quit smoking." should be there either. That's incredibly POV, as well as making claims - delaying or deterring smoking cessation - that have been thoroughly disproven.--FergusM1970^{Let's play Freckles} 13:59, 22 May 2014 (UTC)

New review in Circulation

Not sure if anyone has seen this review yet, but it looks pretty good. [1] Ian Furst (talk) 03:15, 19 May 2014 (UTC)

No, it is not pretty good. It is biased and according to Prof. Dr. M. Siegel: "this article is little more than a hatchet job on e-cigarettes." and:

"To illustrate this, let's consider the five studies which the authors cite as providing evidence that electronic cigarettes inhibit smoking cessation. Presumably, these five studies examined the rate of quitting among smokers who used electronic cigarettes in an attempt to quit smoking. Question: Of these five studies, how many examined the rate of smoking cessation among smokers who were trying to quit using electronic cigarettes?"

Answer: "The rest of the story is that none of these studies examined quit rates among smokers who were trying to quit using e-cigarettes. None of these studies were in fact designed to examine the role of e-cigarettes in smoking cessation in the first place." Source: The Rest of the Story: Tobacco News Analysis and Commentary--Merlin 1971 (talk) 20:03, 19 May 2014 (UTC)

Circulation is a well respected journal. It is a recent review article. Good find. We can definately use this as a source. Now the blog we can definately not use. Doc James (talk · contribs · email) (if I write on your page reply on mine) 01:35, 20 May 2014 (UTC)

Have you read the "review" Doc James? I find the paper questionable, even without looking at Dr. Siegel's blog... First thing that strikes me is: It reads more like policy advice/advocacy than a review, Second thing is how far the "narative" in the paper is from the other reviews that we've examined, Third thing is that the references in the paper seems both incestrous and picked to toe a line (cherry-picking may be too far, but not that far), Fourth the summary of some of the papers do not match well with the description in the papers, and finally the primary authors affiliation is a bit problematic. Now after reading Siegel's commentary, i'm even more critical.

Yep, it is a WP:MEDRS... but frankly i wouldn't use it for the problems mentioned above, and if using it, then i would say that the weight given to the paper must be small considering these observations. Not everything in RS or MEDRS is good. --Kim D. Petersen 21:56, 20 May 2014 (UTC)

Just glanced at it. Read a lot of circulation. It is the journal of the AHA and is very well respected. Doc James (talk · contribs · email) (if I write on your page reply on mine) 23:00, 20 May 2014 (UTC)

Even good journals sometimes print dodgy papers... i'm not questioning the journal at all. --Kim D. Petersen 23:18, 20 May 2014 (UTC)

Some of the language in the "review" doesn't belong in this article. For example: "Although research is limited, it is transparent that e-cigarette emissions are not simply "harmless water vapor," as is commonly claimed." Research is actually extensive - Glantz just won't acknowledge it unless it matches his views - and the way the sentence is phrased practically accuses e-cig manufacturers and harm reduction advocates of lying.--FergusM1970^{Let's play Freckles} 00:35, 21 May 2014 (UTC)

There are some fairly opinionated assertions in there such as "E-cigarette advertising on television and radio is mass marketing of an addictive nicotine product". At the same time this is somewhat odd because under the disclosures section it states that "Dr Benowitz is a consultant to several pharmaceutical companies that market smoking cessation medications".

I also wonder whether a cardiovascular journal is an appropriate place for this review. Very little of the review appears to focus on cardiovascular issues. As an example would the peer reviewers have expert knowledge and experience of propylene glycol breaking down due to heat and forming toxic substances such as acrolein? Levelledout (talk) 01:17, 21 May 2014 (UTC)

This review is written by tobacco experts, and reviewed in an appropriate journal (smoking cessation clearly falls under the purview of a cardiovascular journal as a topic). If it is incorrect, there will be plenty of other reviews that will come to the opposite conclusion and we can add those if/when they are published. That specific editors disagrees with the conclusion or specific tone of the source is not a valid reason to rule a source unreliable. Yobol (talk) 03:36, 21 May 2014 (UTC)

Actually reviewing sources and assessing their individual merit is exactly what we should do. Considering the tone of a source as well as compare it to other reviews, is one of the things that we as editors are supposed to do, no matter whether it is science, medicine, history or politics. In this particular case, the review is written by anti-tobacco advocates, and that tone can be detected in both their conclusions and their tone.

Let me state an example from the paper that i don't think has been commented upon by others: In the review they refer to a study by Dr. Farsalinos regarding the cytotoxicity of flavored e-cig concentrates, and give some results as if these were actual e-liquid for consumption... they weren't (i noticed this because i myself was thinking that i should keep away from cinnamon flavor based on a quick reading at the time), in fact these were the basic food-flavoring (in 100 and 50% solution) that were cytotoxic at concentrate level but not at e-liquid levels (typically with contrate dissolved at 6-20% in PG/VG mix).

So i'd be very careful in using this review as gospel. --Kim D. Petersen 23:41, 21 May 2014 (UTC)

Is it? At least one of the authors is an aeronautical engineer. This is the third study he's produced this year that's attracted ferocious criticism from within the tobacco control community, up to and including accusations of intentional dishonesty, because the conclusions it draws aren't supported by the data. He's making claims about the effectiveness of e-cigs as a quit aid based on studies that didn't ask people if they were using e-cigs as a quit aid. That's activism, not science.--FergusM1970^{Let's play Freckles} 04:01, 21 May 2014 (UTC)

Your personal opinion of the MEDRS compliant source has no weight in the discussion. QuackGuru (talk) 04:09, 21 May 2014 (UTC)

Fergus is entitled to their opinion and has explained their reasoning. Whether the source has taken a neutral approach or is a biased position paper is actually relevant in determining whether it is WP:MEDRS compliant. On the other hand stating that it is WP:MEDRS compliant without providing a reason is insufficient in accordance with WP:CON.

I have tried to think of a compromise to address some of the grievances discussed here and there is only one that I can think of at the moment that would keep personal opinions and unreliable sources out of the actual article. This would be that if this source is used then the disclosures should also be added to the article. For example:

++info about study++ One of the authors of the study "is a consultant to several pharmaceutical companies that market smoking cessation medications and has been a paid expert witness in litigation against tobacco companies"Levelledout (talk) 10:06, 21 May 2014 (UTC)

Another Cessation Study That Has Been Added

See [diff]. The New York Times has been used as the source which obviously does not really conform with WP:MEDRS, the article is I believe based on this press release in the peer-reviewed Addiction journal: [[2]] The study is not actually published until tomorrow (midnight tonight UK time, which is a couple of hours away). It is not a systematic review but it has been peer-reviewed and renowned UK organisations like University College London and Cancer Research are involved. It also seemingly directly addresses the issue of e-cigarettes and smoking cessation in an area where data in general is lacking at present. Although 6000 people took part, I'm not sure of the quality of the methodology of the study, maybe others can comment here and more will obviously become apparent when its published. The question is should we wait for this to be reviewed or should we keep it? — Preceding unsigned comment added by Levelledout (talk • contribs) 21:17, 20 May 2014 (UTC)

Consensus so far has been not to use non-WP:MEDRS sources (and non-reviews) for information such as this. NYT is certainly not a valid source for this. --Kim D. Petersen 21:59, 20 May 2014 (UTC)

What do you mean it is not reliable? This is not an article about Medicine, and the article is not attempting to diagnose or treat a disease. Cwobeel (talk) 22:09, 20 May 2014 (UTC)

The survey and the results are medical data - NYT is not a reliable source for interpreting science. It is a reliable source for many other things though. --Kim D. Petersen 22:12, 20 May 2014 (UTC)

Yes we need high quality secondary sources and position statements of major organizations. Doc James (talk · contribs · email) (if I write on your page reply on mine) 22:59, 20 May 2014 (UTC)

That is a very narrow interpretation of policies, and I respectfully disagree with your assessments. Cwobeel (talk) 00:09, 21 May 2014 (UTC)

There certainly are some narrow interpretations going on here, such as the utterly baseless claim that to be WP:MEDRS a source has to be PubMed-indexed, but in this case it's reasonable to ask for a better source. Like this one.--FergusM1970^{Let's play Freckles} 00:29, 21 May 2014 (UTC)

I think it would be better to follow WP:CON and wait until a consensus has developed on this matter rather than descend into a mini-edit war after almost every post. Levelledout (talk) 00:52, 21 May 2014 (UTC)

The NYT article, and the primary journal article are not WP:MEDRS compliant. When this study is reviewed and placed in context by a MEDRS compliant secondary source like a review article, we can include said information. Yobol (talk) 01:16, 21 May 2014 (UTC)

My previous post was not a complaint that it had been removed, it was a complaint that the information had been reverted back and forth 4 times in the last 24 hours. — Preceding unsigned comment added by Levelledout (talk • contribs) 01:23, 21 May 2014 (UTC)

This approach to argue for WP:MEDRS is totally stupid. This is a survey reported in reliable secondary sources, not an assertion of a cure or a medicine. Cwobeel (talk) 02:29, 21 May 2014 (UTC)

The problem is that you have come to the determination that the NYT is a reliable source for medical claims. It is not. Yobol (talk) 03:31, 21 May 2014 (UTC)

I've asked several times for someone to show me where MEDRS says primary sources can't be used. Zip. Yes, I know it says they can't be used to rebut secondary sources, but MEDRS does not say they can't be used at all.--FergusM1970^{Let's play Freckles} 03:57, 21 May 2014 (UTC)

You should stop asking. Everyone knows primary sources are generally not acceptable. Claiming "MEDRS does not say they can't be used at all" is not the point. We got plenty of good sources. QuackGuru (talk) 04:09, 21 May 2014 (UTC)

Exactly, the issue is that primary sources are allowed, but they are generally considered worse as they are less reliable than secondary sources. Therefore they should only be used when there is a lack of secondary sources concerning a topic, and in this case there is no lack. Any perceived lack due to secondary sources only pointing in one direction should be telling for the stance of the medical community at large. CFCF (talk · contribs · email) 09:12, 21 May 2014 (UTC)

But the secondary sources aren't all pointing in one direction. I know that's the accepted version here, where WHO FAQs are counted as secondary sources and the Smoking Toolkit Survey isn't, but the evidence is in fact quite conclusive that e-cigs are not an obstacle to smoking cessation. Even Glantz seems to acknowledge this; his latest utterance is very revealing.--FergusM1970^{Let's play Freckles} 12:46, 21 May 2014 (UTC)

I quote from the WP e-cigarette article, "The review found no studies that directly measured the effectiveness of electronic cigarettes in smoking cessation". Levelledout (talk) 10:16, 21 May 2014 (UTC)

I'm sure there have been several. The Bullen study, for example, or the Italian one. They consistently find that e-cigs - even cigalikes - are at least as effective as licensed NRT.--FergusM1970^{Let's play Freckles} 15:08, 21 May 2014 (UTC)

Well the review from my previous quote was published in 2011 so that information may be outdated to some extent. My point was as much intended to illustrate the fact that there is a lack of systematic reviews using direct studies on cessation. So other than position statements which echo this decent primary sources are (mainly) all we have. In fact we already have several primary sources in the article's cessation section.Levelledout (talk) 18:34, 21 May 2014 (UTC)

Well here is the study anyway which has now been published: [[3]]Levelledout (talk) 18:34, 21 May 2014 (UTC)

I fail to understand the arguments made here. This study is a survey, not a medical treatment or a quack, or any other medicine-related study. So why are folks here referring to WP:MEDRS???? Enlighten me, please. Cwobeel (talk) 22:14, 21 May 2014 (UTC)

Since the survey you are referring to, is published in a peer-reviewed medical journal, it is classified as science. And as such a summary from a non-science source wouldn't be reliable, regardless of the general reliability of the non-science source, thus the requirement for WP:MEDRS on such info. Newspapers and other such media are generally very poor at summarizing science and interpreting the results. Other than that, the information is interesting, and hopefully will be covered in a review within a short while, and thus end up being written about here. --Kim D. Petersen 22:36, 21 May 2014 (UTC)

So the policy you are then invoking is WP:PRIMARY? I am still confused, sorry. Cwobeel (talk) 22:41, 21 May 2014 (UTC)

Why we can't quote directly from a peer-reviewed article? Cwobeel (talk) 22:42, 21 May 2014 (UTC)

Per WP:SCHOLARSHIP: Many Wikipedia articles rely on scholarly material. When available, academic and peer-reviewed publications, scholarly monographs, and textbooks are usually the most reliable sources. Cwobeel (talk) 22:44, 21 May 2014 (UTC)

You can use the peer-reviewed paper as a source. What you can't do is use a newspaper article about the peer-reviewed paper.--FergusM1970^{Let's play Freckles} 14:46, 22 May 2014 (UTC)

OMG, all this discussion for just saying that the NYT article can't be used, but the peer reviewed article can? This is nuts. Cwobeel (talk) 16:57, 22 May 2014 (UTC)

According to this edit we can't use the peer-reviewed article. User:FergusM1970, you should not delete the peer-reviewed source. QuackGuru (talk) 18:28, 22 May 2014 (UTC)

Regardless of whether removal of the information was right or wrong in this particular case, it must be admitted that WP:CON and WP:NPOV were not adhered to in the first place. WP:CON was not followed due to editing (adding information) during a dispute before a consensus had been reached (same as the FDA information). WP:NPOV, well that one is obvious to a greater extent but included:

• Opinions were stated as facts in Wikipedia's voice
• Judgemental, biased language was used, e.g. "to evade smoke-free laws"
• No attempt was made to indicate the relative prominence of opposing views

Levelledout (talk) 22:42, 22 May 2014 (UTC)

CON was not followed and this was the result. Questioning reliable sources again is not productive. QuackGuru (talk) 23:04, 22 May 2014 (UTC)

I have no intention of commenting on slurs on other editors. However, I politely ask you to consider why these policies might not be being implemented and to respond as they are very important policies, NPOV for example is a "core policy". I am not trying to get into an argument, I am simply trying to improve the article and to do that it is pretty much vital that we are all agreed on following these policies.Levelledout (talk) 00:06, 23 May 2014 (UTC)

Speaking as the implementor of that block, it was a special circumstance that reflected a long standing issue not fully relevant to this conversation. However, that does not mean that your position is incorrect. Levelledout, rather than arguing about whether procedure was followed, can you concisely state what your objections are with the current state of the article? Thanks, NW (Talk) 03:21, 23 May 2014 (UTC)

I think the fact that edits were being made during disputes ([here] for example where an edit was made which disregarded both the FDA and the Circulation Study disputes) is an important issue to raise and sort out and I still think that there is a case to answer.

However, on the separate issue yes I am quite prepared to clearly define all of my general present objections to the article. Unfortunately I don't have time to right now but I will do this when I get this chance, possibly in a new section as it would probably be more appropriate there.Levelledout (talk) 13:23, 23 May 2014 (UTC)

NPOV Edits

Hello, I have made some edits to the lead to try to improve on NPOV. I was going to provide a long list of everything that I thought could be improved with the article but I thought it would just be easier to go ahead and start making some changes to see if people agreed that they were suitable. I have not added any new sources here, just done some rewording, removed a couple of things and moved/copied a couple of others around. It's pretty much all listed below anyway.

My main problems with the content of the article are that opinions are commonly stated as facts, the prominence of opposing views of often not represented and on a minority of occasions content is simply plain biased and partial. All of that obviously comes under the umbrella of WP:NPOV.

If you have a problem with any of what has been done below please reply so we can discuss the issue.

• "They carry a risk of nicotine addiction *to non-smokers*".

Changed (added "to non-smokers") to reflect obvious reality and the actual findings of the study.

• "There are concerns that these products should be adequately regulated, mainly to protect users, while avoiding unintended consequences caused by excessive or inappropriate regulation."

Removed because, in order to reflect the actual conclusions of the study, I would have to change this to something like: "One study stated that the products should be adequately regulated but that this should be done on the basis of an "enabling framework" This would have represented a minority opinion within the medical/academic establishment too prominently, particularly in the lead of the article.

• "while some young people who have never smoked cigarettes have tried electronic cigarettes at least once."

Removed because the scenario is so inevitable that it is statistically meaningless. Of course at least one young person in the world somewhere who has never smoked a cigarette has used an electronic cigarette at least once, at least one young person somewhere in the world who has never smoked a cigarette has used every single other drug in existence at least once and done everything else you could possibly imagine. It doesn't add anything to the article, it just creates a vague impression that there is a problem with e-cigarettes and non-smoking young people, which is not proven, particularly internationally.

• "One study found that frequency of use has increased with up to 10% of American high school students having ever used electronic cigarettes as of 2012 and around 3.4% of American adults as of 2011."

Removed because they are tabloid statistics, that is the highest, most exaggerated ("ever use"), most shocking (children involved) statistics have been selected. Replaced with an opinion from the same study and an opposing opinion from ASH UK. — Preceding unsigned comment added by Levelledout (talk • contribs) 14:31, 24 May 2014 (UTC)

A review article is not a tabloid [4] Thus reverted. Doc James (talk · contribs · email) (if I write on your page reply on mine) 15:48, 24 May 2014 (UTC)

Frequency of use is correlated in that text with ever-use - that is tabloid usage of statistics. What are your comments on the other changes? And how do you propose solving the perceived POV problem? Reverting back didn't resolve that - did it? --Kim D. Petersen 16:31, 24 May 2014 (UTC)

• If someone is already a smoker, they can maintain their addition by using e-cigs thus "to non-smokers" is not really needed. You are correct that the WHO ref didn't support it entirely thus added another ref which supports in those already smoking.
• This [5] is a 2014 review article and is not just the conclusions of "One study"
• There are primary sources that state it is fairly frequent. This second source sees it as notable enough to mention thus there is no concern with us doing the same. Doc James (talk · contribs · email) (if I write on your page reply on mine) 16:53, 24 May 2014 (UTC)

• When stating "risk of addiction" then it begs the question "to whom" and "by what". This is not written for medical professionals.
• So read that as "one review stated" - we have several reviews here, who do not agree with each other.
• Of course there is a concern, particularly because other reviews state that it isn't a concern for instance the Saitta et al(2014) that you mention in your second bullet. I quote "Regulatory authorities have expressed concern about e-cigarette use by youngsters or by never smokers, with e-cigarettes becoming a gateway to smoking or becoming a new form of addiction. However, such concerns are unsubstantiated by existing data that e-cigarette use by youngsters is virtually nonexistent unless they are smokers [Centers for Disease Control and Prevention, 2013; Dockrell et al. 2013; Camengaa et al. 2014] and in fact the use of e-cigarettes may serve as a gateway ‘out’ of smoking [Polosa and Caponnetto, 2013a]." add to this that the British large scale population study finds no statistically significant usage amongst non-smokers (including adolecents)

What you aren't doing here is addressing the weight of the literature which we have to do when writing in an WP:NPOV manner. Reviews aren't agreeing - thus there is a significant discordance amongst scholars on some of these issues (for instance usage amongst youth, and the "gateway idea"), and we can't just use whatever fact we find in a review as being gospel. --Kim D. Petersen 17:23, 24 May 2014 (UTC)

Let me summerize my comment into: Having a secondary sources stating something does not mean that you can uncritically add that information, a secondary source is only the first tier for making content available for use, you still have to address the weight of the literature, and balance between views based on that. --Kim D. Petersen 18:19, 24 May 2014 (UTC)

Doc James, please explain why you felt it necessary to revert the whole edit without keeping any of it? You could also have discussed the situation here first to seek a compromise but you didn't. To be honest you seem to miss the whole point that I am trying to improve the NPOV of the article, you seem more interested in justifying a certain POV instead of engaging in this discussion, I hope I am wrong.

• With regards to the contents, yes the usage statistics were selected in and presented in a tabloid manner which is why they were removed. If we are going to put those statistics there, then why choose those ones from the Usage Statistics section and not the ones that say "among non-smokers under 18, 1% reported having tried e-cigarettes "once or twice," 0% reported continuing use, and 0% intended to try them in the future" (which of course would be equally biased as your proposal)?

• "A risk of nicotine addiction" is not the same thing as "maintaining a nicotine addiction which already exists" and this should be made clear if we are the slightest bit interested in presenting the article in an impartial way.

• With regards to the review article, great if you found a valid source, I have no problem with that. Now you found a source, how about we represent the opposing minority point of view as of WP:NPOV in the original source somewhere in the article which states:

‘there is place for regulation, but it should be to create an “enabling framework” for these new, much less risky, alternatives to smoking to enter the market in a way that gives consumers confidence in switching from smoking’

• I propose we revert back to my edit eventually with whatever compromises are necessary because I think the revert by Doc James was unjustified.Levelledout (talk) 18:21, 24 May 2014 (UTC)

per WP:BRD let us finish the discussion first. You were bold, Doc James reverted, and now we'll discuss it for a bit :) --Kim D. Petersen 18:28, 24 May 2014 (UTC)

We state "They carry a risk of nicotine addiction" to what is obviously "nicotine". Have clarified to "They carry a risk of nicotine addiction in those who do not already smoke,[11] and possibly continue addition in those who already smoke." Doc James (talk · contribs · email) (if I write on your page reply on mine) 19:29, 24 May 2014 (UTC)

(edit conflict)*"Who do not already smoke"? That would indicate that you believe that vaping is smoking. Should be rewritten - non-smokers is significantly more clear.

• Do they really carry such an "addition"? What refs are you using for that. (for instance the Saitta et al(2014) states that such concerns seem to be unfounded). What is the weight?
• Do we have such concerns mentioned in the lede on other nicotine replacement products? Why not? Iirc the Cochrane review states that such is a concern for NRTs. Is it because they are medical products?

-- Kim D. Petersen 19:42, 24 May 2014 (UTC) — Preceding unsigned comment added by Levelledout (talk • contribs)

I have tried a compromise, now changed to

• "There is also a possible risk of continued addiction to nicotine in people who substitute tobacco for electronic cigarettes."

I have also removed (again)

• while some young people who have never smoked cigarettes have tried electronic cigarettes at least once.

If anybody thinks that this should still be in there please clearly justify why. I have given my reasons at the top of this section and nobody has countered them.

The only thing I have a major problem with now is the usage statistics which are still substantially biased IMO. I really don't think we can justify keeping them in there unless we include some other ones that illustrate an alternative POV. Even if you don't agree with all of the other points raised about them, these are US statistics if I'm not mistaken and Wikipedia is not supposed to give special focus to one country. In the UK, completely different conclusions have been reached.

I also think we need to include something positive about e-cigarettes in the paragraph we have been editing because there is nothing in there whatsoever, only neutral and negative opinions. Something along the lines of "e-cigarettes are considered likely to be safer than tobacco according to SO&SO", backed up with a valid source of course. Anyone got any objections to that? — Preceding unsigned comment added by Levelledout (talk • contribs) 20:34, 24 May 2014 (UTC)

This "among non-smokers under 18, 1% reported having tried e-cigarettes "once or twice," 0% reported continuing use, and 0% intended to try them in the future" (which of course would be equally biased as your proposal)?" is from a primary source. Should really be removed from the article but definately should not be in the lead. Doc James (talk · contribs · email) (if I write on your page reply on mine) 19:32, 24 May 2014 (UTC)

I do not see that in the lede, but in the usage statistics section. And it is a secondary source from a major British health organization (ASH). --Kim D. Petersen 19:49, 24 May 2014 (UTC)

The proposal seems to be to put it in the lead and it is a single survey done by ASH. It is not published in a journal. And major, I'm not so sure. This article does comment on it though [6] Am happy to see it continue to be used as it is. Doc James (talk · contribs · email) (if I write on your page reply on mine) 19:59, 24 May 2014 (UTC)

Lots of statements and data from health organizations are used within the article, which have not been published in a journal. You, yourself, even added such a non-journal organization citation in the lede today.[7]. --Kim D. Petersen 22:44, 24 May 2014 (UTC)

It was not a serious proposal and if you re-read my original comment I'm sure you'll realise that. What I said was done to illustrate how biased it appears now with just comment about 10% of American children having ever picked up an e-cigarette possibly once in their entire lifetime.Levelledout (talk) 20:42, 24 May 2014 (UTC)

Joining a lengthy conversation late in the game, but wasn't sure if this new review in the Journal of Psychiatric Research had been noted yet. The CDC hates these things, as does the American Heart Association, the American Cancer Society, The American Association of Pediatrics, the American Society for Clinical Oncology and the World Health Organization. I apologize for joining the conversation late, especially if the above has already been discussed, but who is on the other side of this issue such that we should not present these as an overall negative for public health as the mainstream position? Best Formerly 98 (talk) 20:48, 24 May 2014 (UTC)

Yep, there seems to be a rather huge divide between a puritan and a harm reduction approach to the subject at hand. Much of which seems to divide the European and US approaches to the topic. (albeit not entirely - both have their proponents on each side of the pond) --Kim D. Petersen 21:06, 24 May 2014 (UTC) [Sorry bit of a hurry here - saw the question late. Read the recent reviews by (Grana et al(2014)) and compare to (Saitta et al(2014)) which kinda shows the two different stances towards the same data. --Kim D. Petersen 21:10, 24 May 2014 (UTC)

Thanks I'll look at the reviews. But I think its a lot more complicated than simply writing the folks onthe other side of the issue off as "puritans" and proclaiming those who agree with you as "harm reducers". Formerly 98 (talk) 22:45, 24 May 2014 (UTC)

I think you misunderstand me. I do not write them off by naming these two approaches - i was using the description that Prof. Robert J. West[8] was recently using in an interview. Neither of those two approaches are inherently right or wrong, they are simply different views upon the same. Call them paradigms if you will :) --Kim D. Petersen 22:52, 24 May 2014 (UTC) - as an example of how the harm-reduction approach is gaining in the UK, there is a new report (May 2014) for Public Health England that illustrates this (and describes them)[9]. --Kim D. Petersen 23:28, 24 May 2014 (UTC)

Well Kim, whoever came up with that nomenclature, its seems like an obvious attempt to trivialize the views of those on one side of the issue by defining them as choosing outmoded scruples over real life benefits. I don't think its use will help faciltitate communication Formerly 98 (talk) 02:27, 25 May 2014 (UTC)

Well what a surprise, QuackGuru has done another one of their covert edits where he has reverted my compromise entirely without even bothering to mention it anywhere. And added a bunch of POV material for good measure of course Levelledout (talk) 00:51, 25 May 2014 (UTC)

I disagree with your changes because your changes were not an improvement. QuackGuru (talk) 01:25, 25 May 2014 (UTC)

Could you please argue your disagreements, instead of assert, and edit-war them? --Kim D. Petersen 01:44, 25 May 2014 (UTC)

"I disagree with your changes because your changes were not an improvement" is the anti-thesis of an argument. Unfortunately you have to provide actual reasons, simply saying "I don't like it" is meaningless.Levelledout (talk) 02:35, 25 May 2014 (UTC)

Two new reports by Public Health England on E-cigarettes.

• Britton, John; Bogdanovica, Ilze (May 15, 2014), Electronic cigarettes - A report commissioned by Public Health England (PDF), Public Health England {{citation}}: Cite has empty unknown parameter: |1= (help)
• Bauld, Linda; Angus, Kathryn; de Andrade, Marisa (May 15, 2014), E-cigarette uptake and marketing - A report commissioned by Public Health England (PDF), Public Health England

--Kim D. Petersen 23:37, 24 May 2014 (UTC)

Press release page[10] --Kim D. Petersen 23:38, 24 May 2014 (UTC)

Please explain how this is NPOV.

Could someone explain to me how this edit by User:QuackGuru represents a WP:NPOV representation of the literature?

Although the evidence is limited, research points to high levels of dual use of e-cigarettes with traditional cigarettes, no proven cessation assistance, and a rapid increase in youth initiation with e-cigarettes.

This is based on the very recent Grana(May 2014) review, but considering that another recent review Saitta(march 2014) has this to say (i've ignored dual use in the below):

• No proven cessation assistance:

  Today, a growing body of scientific studies on e-cigarettes and liquids supports the efficacy and safety of these products. Even smokers who do not want to quit may do so when introduced to e-cigarettes [Polosa et al. 2011, 2013] and the overall level of risk is much lower than cigarette smoking, with no chemicals raising serious health concerns in e-liquids [Cahn and Siegel, 2011; Goniewicz et al. 2013]. In the most comprehensive systematic review of chemical studies to date, Burstyn concluded that there is no evidence that ‘vaping’, that is neologism, coined to indicate the act of vaporizing the liquid contained in e-cigarettes, produces inhalable exposures to contaminants of aerosol that would warrant health concerns [Burstyn, 2013]. However, chronic inhalation data in humans are needed before any definite conclusions are made.

• Youth initiation:

  Regulatory authorities have expressed concern about e-cigarette use by youngsters or by never smokers, with e-cigarettes becoming a gateway to smoking or becoming a new form of addiction. However, such concerns are unsubstantiated by existing data that e-cigarette use by youngsters is virtually nonexistent unless they are smokers [Centers for Disease Control and Prevention, 2013; Dockrell et al. 2013; Camengaa et al. 2014] and in fact the use of e-cigarettes may serve as a gateway ‘out’ of smoking [Polosa and Caponnetto, 2013a].

How can we then use Wikipedia's voice to state the first as fact? Does WP:MEDRS negate WP:NPOV and WP:WEIGHT? (representing views appropriately and balanced according to their prevalence in reliable secondary sources)? This is only one of my problems with recent edits. --Kim D. Petersen 20:19, 25 May 2014 (UTC)

(edit conflict):As a further comment: This seems to be symptomatic here, that editors consider a WP:MEDRS review to be gospel, and that they can indiscriminately use what is written within such, without considering what the WP:MEDRS literature en masse is saying. --Kim D. Petersen 20:27, 25 May 2014 (UTC)

We are not asserting it as fact because there is a qualifier: "Although the evidence is limited,...". QuackGuru (talk) 20:26, 25 May 2014 (UTC)

That does not explain how you can use this as if it is fact, and not consider the rest of the literature on the topic. This is one view stated as fact. --Kim D. Petersen 20:28, 25 May 2014 (UTC)

If the qualifier was removed then you would have an argument. The text clearly stated the evidence is limited. QuackGuru (talk) 20:36, 25 May 2014 (UTC)

The text including the qualifier is written in Wikipedia's voice, as if fact. And as my above quotes show, neither the text without, nor with the qualifier is undisputed fact. --Kim D. Petersen 20:43, 25 May 2014 (UTC)

You haven't shown there is a dispute that the "evidence is limited". QuackGuru (talk) 20:50, 25 May 2014 (UTC)

I'm sorry? The sentence is composed of more than the first few words. Even if we agree on "the evidence is limited" - there are several other claims/assessments made in that sentence that are not supported by a weighted neutral reading of the literature. --Kim D. Petersen 20:55, 25 May 2014 (UTC)

The source indicates "the evidence is limited" and no evidence to the contrary has been presented. You haven't shown that the text is not supported by a weighted neutral reading of the literature. QuackGuru (talk) 06:18, 26 May 2014 (UTC)

POV tag

I've tagged the article with POV now. There are several unresolved threads relating content already here on the talk-page, and still more content is added to the article that relies on a single review. The changes to the lede, relating to this, such as a sentence such as:

The e-cigarette aerosol delivers nicotine, ultrafine particles, other toxic chemicals, and carcinogens.[1] There is a poor relationship between labeled and existing nicotine content, as well as differing levels of other chemicals and toxicants in the e-liquid and aerosol.[1]

Is putting significant weight on something that i haven't seen other reviews do, and seem to indicate that some editors simply want to describe this topic as negatively as possible. --Kim D. Petersen 13:11, 26 May 2014 (UTC)

There is no issue if the question hasn't even been raised. I see your discussion above, where I fail to see an argument. You can't just say "I don't like this sentence" and tag an entire article NPOV. What is the issue here? CFCF (talk · contribs · email) 13:35, 26 May 2014 (UTC)

Please do not remove the tag while there are active discussions about the neutrality of the article. The tag is there to attract editors with different viewpoints to edit or give additional insight. --Kim D. Petersen 14:56, 26 May 2014 (UTC)

I agree that the neutrality of the article is seriously compromised, I have personally highlighted my reasons for one paragraph of the article alone in the section "NPOV Edits above". Since all of my original changes have been reverted, this is still relevant.

What I have said in the NPOV Edits section is relevant to the rest of the article, also the Grana study has been grossly overused to push a particular POV and, for example, simply sticking "despite the fact that evidence is limited" in front of a very partisan statement does not mean it has been presented in an impartial way. I may add some more to this argument later.

Levelledout (talk) 15:25, 26 May 2014 (UTC)

I'll just add that I mainly listed my actual objections regarding neutrality near the end of the "Another Cessation Study Has Been Added" section.Levelledout (talk) 15:37, 26 May 2014 (UTC)

Unfortunately, more highly contentious material continues to be added to the article, presented as absolute fact such as:

• "The e-cigarette aerosol contains nicotine, ultrafine particles, other toxic chemicals, and carcinogens"

Other content has questionable relevance and is simply being used to push a POV, again presented in a highly opinionated manner stated as fact:

• "A disproportionate use of flavored traditional tobacco products are used by youth and initiators, and flavored cigarettes except menthol have been banned in the U.S."

Yet further material has been added in a partisan, highly opinionated manner:

• "The e-cigarette brands have been rapidly expanding using aggressive marketing campaigns similar to those used to popularize cigarettes in the 1950s and 1960s."

And this has crept in somewhere along the line for good measure:

• "There is a poor relationship between labeled and existing nicotine content, as well as differing levels of other chemicals and toxicants in the e-liquid and aerosol."

There are in fact 26, yes 26, separate references to the Grana study in the article.Levelledout (talk) 17:48, 26 May 2014 (UTC)

An article wide POV tag is not justified. The purpose of the tag is to attract editors with a variety of viewpoints and we have that already. There is no indication that all sections of the article have POV problems, which is what an article wide tag indicates. There is a relatively minor disagreement over weight. The article wide tag should be removed. Zad68 17:55, 26 May 2014 (UTC)

Since it is quite apparent that there isn't a lot of editors discussing the various issues here on talk - then an influx is needed. As far as i can tell, we have a few independent editors, and the rest are all from the WP:MED project, which not in itself is bad, but also means that they come with a certain POV attached, and a lack of knowledge about the topic itself. --Kim D. Petersen 18:16, 26 May 2014 (UTC)

And the trouble is spread all over the article at this moment. And it involves the lede as well, that makes it not a point-problem, but a systematic one. --Kim D. Petersen 18:21, 26 May 2014 (UTC)

To illustrate: Since i added the tag, and described my problems with relying on a single review, 7 new additions to the article, in 5 different sections, citing this review has been added[11] without any discussion (or apparent critical reading of what other reviews say). --Kim D. Petersen 18:35, 26 May 2014 (UTC)

The tag has to go. No legitimate reason has been given to keep the tag. QuackGuru (talk) 18:05, 26 May 2014 (UTC)

I'm aware that you can't see the problems, which is one of the problems. The reliance on ONE source alone in your edits, is one major POV problem here - we need a balanced approach taking all reliable sources into account, and determining the individual merit and weight of each issue from the sources. --Kim D. Petersen 18:19, 26 May 2014 (UTC)

And there we go - another revert of the tag[12] without even marking it up as a revert. Sigh. Not going to try to edit-war it, it simply confirms the POV problems to me, and indicates WP:OWN problems on top. --Kim D. Petersen 18:54, 26 May 2014 (UTC)

All these amendments in connection to _one_ (biased) paper, which says exactly the opposite of a large majority of published papers -> This article does need the POV-Tag for sure! --Merlin 1971 (talk) 19:11, 26 May 2014 (UTC)

I think this dispute should be escalated, it is a ridiculous situation, most of us have no control or say over the article whatsoever. I personally do not have the experience to escalate the dispute, hopefully someone else does. I am quite prepared to help in anyway I can.Levelledout (talk) 20:35, 26 May 2014 (UTC)

Did not realise POV tag had been reinserted. I retract my previous comment regarding escalation for now but reserve it for immediate future use should the POV tag yet again be edit-warred out of the article.Levelledout (talk) 21:02, 26 May 2014 (UTC)

POV tag is absolutely justified. Claims like: "The e-cigarette aerosol delivers nicotine, ultrafine particles, other toxic chemicals, and carcinogens." are written in a incendiary fashion that only presents half truths. The source clearly sates that "The levels of toxicants in the aerosol were 1 to 2 orders of magnitude lower than in cigarette smoke but higher than with a nicotine inhaler". Just stating that e-cigs deliver crap without saying how much of the said crap is being delivered is biased. — Preceding unsigned comment added by 184.70.5.58 (talk) 04:58, 27 May 2014 (UTC)

Then this could easily be changed, we don't need an article wide-tag for that. CFCF (talk · contribs · email) 06:52, 27 May 2014 (UTC)

Since the problems raised so far are all over the article, the problem is systematic, and not a point-problem. What is it that is so scary about attracting more editors to take a look at the problem? Please adhere to what the tag states "Please do not remove this message until the dispute is resolved.", and check WP:NPOVD so that we can get on. --Kim D. Petersen 13:18, 27 May 2014 (UTC)

Looking at this from the outside, I'd offer the following commnents:

• Electronic cigarettes are almost certainly better for you than smoking, and almost certainly worse for you than using nothing at all. So the harm reduction issue comes down to how large these differences are and whether e-cigs are used by significant number of people to reduce or eliminate their smoking habit, vs being used as a recreational drug or introducing people to smoking. For all the back and forth, it really looks like they are too new for these things to be known with certainty. Instead of trying to split hairs based on limited evidence, the article should probably just acknowledge this uncertainty.
• About half of this article consists of bulleted lists of the legal status of e-cigs in various countries and local jurisdictions around the world. What is this, some kind of a vote? This needs to be condensed, its nothing more than a POV battleground.
• The "Construction" section reads a little bit like an advertisement. This level of detail seems to me to be of interest only to someone who is getting ready to go shopping. I'd suggest cutting it back to a level that is more appropriate to an article aimed at a general audience rather than aficianados.

Just my 2 cents Formerly 98 (talk) 13:40, 27 May 2014 (UTC)

Agree allmost entirely with your 1st point, and to a large degree with your 2nd, not as much on your 3rd, since this really is an article about e-cigarettes, with the medicine/health part as an important part... ie. depends on who you are writing for. E-cigs cannot be described that simple, there are too many terms/variables on the construction. --Kim D. Petersen 14:27, 27 May 2014 (UTC)

I agree completely with the statements, but I don't really see how the article does anything but present the fact that there is limited evidence. As for the second suggestion, I went ahead and implemented it at once. CFCF (talk · contribs · email) 14:50, 27 May 2014 (UTC)

Use the Wikipedia DR pathways to address specific issues instead of article-wide tagging

Despite the words used, those arguing for the article-wide POV tag appear to be trying to tag the article with a "badge of shame" rather than respect Wikipedia processes and content guidelines. The call for "Do not remove the tag until consensus is achieved!" is most often a ruse, because naturally what happens is those arguing keep arguing to ensure the tag stays until their preferred version is achieved, regardless of whether their preferred version is actually what Wikipedia content guidelines call for. Instead, use the normal dispute resolution pathways such as an RFC, NPOVN, RSN, DR, etc. These pathways usually have a limited lifespan with an outcome that can be adjudicated as either finding consensus for or not finding consensus for a specific change. Once the pathway has be exercised, the discussion can be closed and put behind us so that the article remiains stable. Zad68 15:31, 27 May 2014 (UTC)

No, i'm not trying to tag it for a "badge of shame", i'm trying to get more editors to look at these issues. The POV tag can be silently removed if the discussions peter out, or the problems are resolved. And i'm not calling for an "until consensus is achieved", and i don't believe anyone else does so either, that is a strawman. RFC's, NPOVN, RSN are for point-issues not for systemic problems, and it is my contension that the problems at the moment are systemic. --Kim D. Petersen 15:38, 27 May 2014 (UTC)

Additionally, you may want to look at WP:AGF, since your comment is lacking this. --Kim D. Petersen 15:42, 27 May 2014 (UTC)

Kim, pick the lowest-hanging fruit--the most glaringly obvious specific issue with the article. Frame it in the form of a specific change: "I propose where the article says X, it should say Y, because of Z." Start an RFC or NPOVN or RSN or DN discussion, your choice. After that's started, please drop a note here. Also notify WP:MED as appropriate. That's the way to actually start seeing whether there's support from a wide variety of experienced editors for your proposed changes. Zad68 15:46, 27 May 2014 (UTC)

I propose that we take each usage of the Grana2014 review, and look at whether the wording used is balanced compared to the other WP:MEDRS reviews that we have. In the last 3 days, this reference has gone from not being used, to dominating the article, in every section. And not even that, it has been used, in almost every instance, as if it was uncontested fact, where every other usage of reviews have been prefixed with "a <year> review found that".

This is a rather systemic problem in the article at the moment. --Kim D. Petersen 15:52, 27 May 2014 (UTC)

Are the issues you perceive with the use of this review just in the section Health, or do you also perceive issues with the few uses of this review in the non-Health sections too? Can you pick one use of this review, the most obviously incorrect one, and make a concrete suggestion based on it? Zad68 16:01, 27 May 2014 (UTC)

The usage is problematic in almost all sections, as i mentioned several times above. Perhaps you should look at the discussions that are located above this tag one - because almost all address such problems. --Kim D. Petersen 16:04, 27 May 2014 (UTC)

This is the last comment/suggestion I'll make here and then it will be up to you to show if your focus is on using the WP DR pathways to drive a particular issue to conclusion or if your interest is just general tagging: Pick one issue, frame it as a change request from X to Y because of Z, start the appropriate process. When it concludes, the change proposal either will find support or it won't, but it will be closed. Then move on to the next one. Zad68 16:09, 27 May 2014 (UTC)

first problem - second usage of Grana2014

(edit conflict)Lets go for the second usage of Grana2014 in the lede:

"The e-cigarette aerosol delivers nicotine, ultrafine particles, other toxic chemicals, and carcinogens.[1]"

Is that even correct? Is that really all what is the default constituents of the aerosol (ie. for e-cigs generally), and does it really contain this much toxic chemicals and carcinogens that it can be stated this clearly and prominently? Do other reviews make such a focus? And if this is really the case, then why are other reviews stating that there is uncertainty as to the dangers? Removal would be my recommendation here. --Kim D. Petersen 16:13, 27 May 2014 (UTC)

Quote from the Saitta2014 review: "the overall level of risk is much lower than cigarette smoking, with no chemicals raising serious health concerns in e-liquids [Cahn and Siegel, 2011; Goniewicz et al. 2013]" to compare with. --Kim D. Petersen 16:22, 27 May 2014 (UTC)

In comparing the relative strengths of the sources, I see that Grana 2014 is published in the well-respected, AHA-affiliated, MEDLINE-indexed journal Circulation and the article is specifically reviewing the health effects and safety of e-Cigs. In contrast the Saitta review is published in a Sage journal that is not MEDLINE-indexed. Off the top I'd expect that Grana should be given significantly more weight. I see you are the only one specifically arguing for giving equal validity to Saitta. Either accept that consensus is against you here, or try one of the DR boards I mentioned. Zad68 16:59, 27 May 2014 (UTC)

Sigh! First of all, congratulations on asserting consensus without considering other input. I'm using Saitta only because it is just as recent a review as Grana (which btw. is PMID: 24821826 [PubMed - in process]), and have at no point stated that it should be given equal weight. i cannot recall any other review being as affirmative as Grana. But i will check.

Can you please quote me the section in Grana that supports that sentence, in light of the questions i asked? --Kim D. Petersen 17:52, 27 May 2014 (UTC)

I apologize for responding without a specific change proposal from you. Still waiting for your specific change proposal so that we can eliminate the possibility of misunderstanding exactly what change you're proposing. Zad68 17:57, 27 May 2014 (UTC)

Wait, you DID have a proposal: Remove the use of Grana 2014 here entirely, correct? Your suggestion is to fix the weight problem by removing Grana 2014 entirely? Zad68 17:59, 27 May 2014 (UTC)

Have you found the location in Grana2014 that supports the sentence? Here is btw. a few quotes from Grana (search for toxic or ultrafine):

• Given these uncertainties, it is not clear whether the ultrafine particles delivered by e-cigarettes have health effects and toxicity similar to the ambient fine particles generated by conventional cigarette smoke or secondhand smoke.(Grana et al)
• Tests on e-cigarettes show much lower levels of most toxicants, but not particles, than conventional cigarettes. The thresholds for human toxicity of potential toxicants in e-cigarette vapor are not known(Grana et al)
• However, subjects should be informed that, although e-cigarette aerosol is likely to be much less toxic than cigarette smoking, the products are unregulated(Grana et al) --Kim D. Petersen 18:27, 27 May 2014 (UTC)

Since apparently the Saitta review is not usable here - because it is not in a MEDLINE journal - lets go to the Caponnetto(2013) review for much the same:

Electronic cigarettes use the process of vaporisation rather than combustion and the low operating temperature of the atomiser (about 50-60°C; approx. 5-10% of the temperature of a lit cigarette) suggests that these products as a class are unlikely to emit cigarette toxicants in their mist [25].

This in a section about toxicology that doesn't raise any such concerns as the lede sentence makes. --Kim D. Petersen 22:00, 27 May 2014 (UTC)

Continuing from Caponnetto:

The data noted above suggests that electronic cigarettes are safer than tobacco cigarettes [28] and comparable in terms of tobacco-specific nitrosamines (TSNAs) levels to conventional nicotine replacement products [37].

as well as

In fact, this tool appears to be much safer than traditional cigarettes and comparable in toxicity to conventional nicotine replacement products [28].

So where does the weight on this come from? --Kim D. Petersen 22:02, 27 May 2014 (UTC)

continuing usage of Grana2014 in lede

When considering that WP:LEAD states that:

The lead should be able to stand alone as a concise overview. It should define the topic, establish context, explain why the topic is notable, and summarize the most important points—including any prominent controversies.[1] The notability of the article's subject is usually established in the first few sentences. The emphasis given to material in the lead should roughly reflect its importance to the topic, according to reliable, published sources. Apart from trivial basic facts, significant information should not appear in the lead if it is not covered in the remainder of the article.

Does anyone consider this, from the first paragraph of the lede to be balanced, or a summary of the salient points in the article body? Personally i must say that it reads like an Inductive fallacy:

There is a poor relationship between labeled and existing nicotine content, as well as differing levels of other chemicals and toxicants in the e-liquid and aerosol.[1] Various e-liquid flavors include tobacco, menthol, coffee, fruit, candy, and alcohol flavors, as well as odd flavors like cola and Belgian waffle.[1] A disproportionate use of flavored traditional tobacco products are used by youth and initiators, and flavored cigarettes except menthol have been banned in the U.S.[1]

After the Inductive fallacy of implying that flavours are there to induce youths to vape... and the implications that since menthol is banned in smokes, it should also be in vaping, we haven't even left the first paragraph of the lede. --Kim D. Petersen 16:49, 27 May 2014 (UTC)

Kim would you please make a specific suggestion to improve the wording here? Zad68 17:50, 27 May 2014 (UTC)

Considering your assertions of consensus where none is evident above - i can't really see the use. Lets take the above first, and let you demonstrate that there actually is a consensus on that sentence, and that it is even supported by the actual review. --Kim D. Petersen 17:55, 27 May 2014 (UTC)

If you're finding communication difficult here on the Talk page consider starting a DR discussion. Zad68 18:04, 27 May 2014 (UTC)

No, i'm finding the point-approach to a systemic problem to be rather silly. And i also find that it seems that a lot people here are entirely unfamiliar with the literature as a whole, and thus cannot see that relying on a single review/secondary source is detrimental to the overall picture. --Kim D. Petersen 22:14, 27 May 2014 (UTC)

Legal status of Electronic Cigarettes

Because the article has grown significantly I found it of value to split the legal section into a new list-class article. It is possible we ought mention a little more than I left here, but I think this is an improvement which adds to the overall readability of the article. CFCF (talk · contribs · email) 14:48, 27 May 2014 (UTC)

This is getting too POV. We are now claiming E-cigs are as dangerous as cigs.

These new edits[13], now have our article state that:

Electronic cigarettes are generally perceived erroneously as less hazardous than traditional cigarettes, when their health risk is similar.[16]

Considering that the reference given is O'Connor(2012)[14] which specifically states:

The limited data available suggest that the products are not likely to approach the health hazards of cigarettes (page 6)

I'm flabbergasted - truly flabbergasted. --Kim D. Petersen 18:56, 27 May 2014 (UTC)

Kim you are correct, the content isn't supported by the source cited. The source cited is making that comment about "Smoked forms of tobacco" and not e-cigs. QuackGuru it appears in this edit, the content provided isn't supported by the source. It looks like you're summarizing the intro paragraphs of the source, which is talking about smoked tobacco products, not e-cigs. Can you please double-check and correct as necessary. Zad68 19:06, 27 May 2014 (UTC)

I checked it again and made the corrections. QuackGuru (talk) 19:25, 27 May 2014 (UTC)

And why do you now start to talk about smokeless tobacco in the article? It is not even within the topic area. Snus and e-cigs have nothing except nicotine in common. What was wrong with the old sentence? " Electronic cigarettes should have fewer toxic effects than traditional cigarettes," which is supported by just about every review out there (including Grana)? And which was removed with the text "Mass original research." --Kim D. Petersen 19:31, 27 May 2014 (UTC)

I moved the text to smokeless tobacco. The old sentence was replaced with the new sentence: Limited evidence suggests e-cigarettes are safer than real cigarettes, and possibly as safe as other nicotine replacement products.[12] QuackGuru (talk) 19:45, 27 May 2014 (UTC)

Image

A logged-in account and an IP added similar text unrelated to the image. QuackGuru (talk) 08:41, 28 May 2014 (UTC)

The image is unrelated to the section in which it appears in the first place. The trivial fact that some people use e cigs to circumvent smoke free laws does not warrant a huge image as if it a huge deal. I would remove it entirely. — Preceding unsigned comment added by 184.70.5.58 (talk) 14:22, 28 May 2014 (UTC)

(edit conflict)Here are 3 questions User:QuackGuru:

• Why is the text unrelated?
• Why would your text be more related?
• Which has more WP:WEIGHT in the section: A) Smoking cessation B) Circumvention of smoke-free areas? (does B in fact have more than 1 sentence?)

--Kim D. Petersen 14:28, 28 May 2014 (UTC)

Lead too detailed

I absolutely agree that the lead of this article is to heavy. Some authors seems more interested in describing the negative effects of the e CIG rather than describing the actual device. The bulk of the intro should be transferred into the health section of the article. — Preceding unsigned comment added by 209.91.107.161 (talk • contribs)

Report of Prof. Dr. Britton

I have to stress that explicit: Public Health England commissioned a background paper on e-cigarettes from Professor Dr. John Britton (Professor of Epidemiology, Director of the UK Centre for Tobacco Control Studies, School of Community Health Sciences, Division of Epidemiology and Public Health) an huge expert on tobacco and tobacco control leviathan who had published dozens of scientific papers, reviews and studys. THIS is real science - Read it and compare it to the review of Gana, N. Benowitz and Glantz. At least the WP-Article has to present both papers in contrast - with emphasis on the review of Britton, because his paper is backed by major reviews and studys!--Merlin 1971 (talk) 17:07, 28 May 2014 (UTC)

As several of us have pointed out above, the massive reliance on the Grana paper is a problem. There are several papers that provide differing views, such as the Caponnetto(2013), Saitta(2014), ... and the National Health England report as well. Also (imho) the focus being taken from the Grana review is significantly slanted by a negative selection of disassociated parts in that review. --Kim D. Petersen 17:43, 28 May)

original reasearch

The Grana review says this: Goniewicz et al41 analyzed the aerosol from 12 brands of e-cigarettes, a conventional cigarette, and a nicotine inhaler for toxic and carcinogenic compounds. "The levels of toxicants in the aerosol were 1 to 2 ORDERS OF MAGNITUDE LOWER THAN IN CIGARETTE SMOKE but higher than with a nicotine inhaler ". 1 to 2 order of magnitude lower than in cigarette smoke = 10 to 100 times lower than traditional cigarettes. Why the Original Research tag? 64.66.22.160 (talk) 19:21, 28 May 2014 (UTC)

User:QuackGuru apparently doesn't want to answer that. I asked much the same question on his talkpage[15], specifically because he, himself, had added the 1 to 2 orders of magnitude, no more than 24 hours earlier.... the answer was to "cleanup"[16]. I'm still curious though. --Kim D. Petersen 19:38, 28 May 2014 (UTC)

Goniewicz et al(2013) [the primary source that Grana(2014) cites] is more specific with 9-450 times lower, the orders of magnitude language is from Grana(2014)... Saitta(2014) also notes "All testing of vapour to date has found no evidence that exhaled vapour produces exposures to contaminants that would warrant health concerns by the standards that are used to ensure safety of workplaces [Cahn and Siegel, 2011; Goniewicz et al. 2013]." which seems interesting in this context. --Kim D. Petersen 19:48, 28 May 2014 (UTC)

The e-cigarette aerosol contains nicotine, ultrafine particles, other toxic chemicals, carcinogens, and metal nanoparticles.[1]

The low level details are in the body. Where does the source say metal nanoparticles were 10 to 100 times lower than traditional cigarettes?

The article says: The aerosol was also found to contain other metals, such as nickel, 2 to 100 times greater than detected in Marlboro cigarette smoke.[1] 10 to 100 times lower than traditional cigarettes is a broad statement that is misleading. QuackGuru (talk) 19:53, 28 May 2014 (UTC)

Nb. the amount of Nickel found in e-cigs was roughly the same as found in the licenced NRT inhalator (also noted in Grana(2014)) --Kim D. Petersen 20:09, 28 May 2014 (UTC)

Your addition of the sentence that the aerosol contains these elements is more likely based on original research, it is certainly not a summary of the body of our article - nor does it follow from a reading of other relevant WP:MEDRS reviews that such a focus can be put on toxins and carcinogens. I would remind you that i've asked several times (above) for the sentence in Grana(2014) that supports that assertion.

If we take the WP:WEIGHT of all WP:MEDRS sources, then they all state that (paraphrased): "Much less dangerous that cigs, comparable to other NRT's in substances measured for". So the focus taken in the sentence you quote is very much WP:POV (ie. not representing fairly, proportionately, and, as far as possible, without bias, all of the significant views that have been published by reliable sources on a topic) --Kim D. Petersen 20:04, 28 May 2014 (UTC)

You have ignored my comment and the source does say it... "still contains nicotine, ultrafine particles, other toxic chemicals, and carcinogens." QuackGuru (talk) 20:14, 28 May 2014 (UTC)

Since i commented on your comment User:QuackGuru, it is rather impossible for me to have ignored it - isn't it? There are 3 instances of usage of "still" in the Grana(2014) paper - none of which is followed by "contains nicotine" - would you like to try again? And you still haven't addressed the WP:WEIGHT issue. --Kim D. Petersen 20:18, 28 May 2014 (UTC)

The section under "What Is Known About E-Cigarettes?" says "still contains nicotine, ultrafine particles, other toxic chemicals, and carcinogens."[17] QuackGuru (talk) 20:25, 28 May 2014 (UTC)

(edit conflict)User:QuackGuru are you aware that the link you just provided isn't to the review? And that it isn't the paper cited in our article? The one you link to is PMID:24821830[18] the one in our reference list is PMID:24821826[19]. The latter is the review, the former is not. How many such mistakes have you made? --Kim D. Petersen 20:32, 28 May 2014 (UTC)

Anyways.. I am planning on doing a whole bunch of deleting in the intro section later when I get home. As stated earlier, the intro of this article is now ridiculously long and littered with crap that belongs in the health section (if they even belong there at all)209.91.107.161 (talk) 20:27, 28 May 2014 (UTC)

Yet more POV problems .. 1/3 of youth who use e-cigarettes never touched a cigarette...

Our article states:

Although the majority of youth using e-cigarettes are dual users, one third of young people who used an e-cigarette have never tried a traditional cigarette, indicating that some young people are initiating use of the addictive drug nicotine through e-cigarettes.(Grana(2014))

This should have alarmbells chiming by everyone who has read the literature on this subject, and who've seen for instance the National Health England report or the new Brown et al(2014) paper about British usage of e-cigarettes. So i digged, this is cited to the Grana(2014) review, where it is stated in the Policy recommendation section without citation, but User:QuackGuru apparently took it[20] from the prevalence section in the paper, and here it says:

The Utah Department of Health found that 32% of ever e-cigarette users reported that they had never smoked conventional cigarettes.34

So we are stating a Utah finding as global fact in our article at the moment...

Even more curiously, if we dig further is that ref 34 in the Grana paper is a blog posting[21] by Stantz (co-author), which points to a Health Status Update[22] by the Utah Health Department. Which says:

PNA data also show that 31.7% percent of students who reported ever using e-cigarettes say they have never tried conventional cigarettes. This raises concerns that electronic cigarettes could serve as a gateway drug for conventional cigarettes.

So now we have:

• A regional health statistic becomes cited as global fact.
• ever-use of e-cigs, becomes usage.

And people are wondering why singular reliance on Grana(2014), and stating its findings as fact, is so problematic. --Kim D. Petersen 22:02, 28 May 2014 (UTC)

Read under Prevalence: "Although dual use with cigarettes is high, some youth experimenting with e-cigarettes have never tried a tobacco cigarette, which indicates that some youth are initiating use of nicotine, an addictive drug, with e-cigarettes." "Similarly, in 2011 in Korea, 15% of students in grades 7 through 12 who had ever used e-cigarettes had never smoked a cigarette.10" Here is the full text. QuackGuru (talk) 22:24, 28 May 2014 (UTC)

Did i question "some X went to e-cigs without smoking first"? Nope! I questioned the rather encompassing claim now in our article that 1/3 of youth go to e-cigs without touching cigs first. And that is not supported by your quote. 15% is not 33%. You still do not see a problem? --Kim D. Petersen 22:29, 28 May 2014 (UTC) -- interestingly btw. the Korean study[23] is published by ..... Grana & Glantz (+ first author Lee). So they cite themselves for that factoid. --Kim D. Petersen 22:39, 28 May 2014 (UTC)

This is (very!) weird, because other scientists has discovered completely different data. Example:

Prof. Dr. Dautzenberg: "The President of the French Office for the Prevention of smoking was the first to worry about the incentive effect of the e-cigarette there two years ago. According to the survey, many young people have taken to the new device: in 2014, over 90% of smokers had puffed on an e-cigarette, as well as 23% of non-smokers. In one year, experimenting with e-cigarettes which from 12 years has doubled and is at its height for 16-17 year olds: with 53% having held one in their hands. By comparison, the number of students lighting a cigarette once out of school has reduced significantly: 20% of 12-15 year olds smoked in 2011, it is now 11.2%. Same dynamic in high school, where 33.5% of students smoked in 2014, against 42.9% in 2011."

Action on Smoking and Health UK: "The anti-tobacco charity Ash (Action on Smoking and Health) says the number of e-cigarette users has tripled from 700,000 in 2012. Nearly two-thirds of users are smokers and the other third are ex-smokers, Ash says, while use of the devices among non-smokers is negligible, at only 0.1%.

The "Grana paper" is cherrypicking (and misinterpretating) appropriate single datasets to justify biased conclusions.--Merlin 1971 (talk) 22:44, 28 May 2014 (UTC)